1. Field of the Invention
We, Biagio Ravo and Enrico Nicolo, have developed improvements which relate to the field of surgery and, particularly, our invention relates to a hollow viscus (intestine, vascular, urinary, etc.) resection and reconstruction device for hollow viscus surgery. The following discussion will relate to colon surgery, but the same can be applied in any hollow viscus surgery.
2. Background Information
The techniques of resecting a segment of the colon or intestine and an anastomosis of the cut ends are common procedures where a segment of diseased bowel must be removed for reasons such as inflammation, oncological process, obstructions, bleeding, perforation, trauma, etc. A conventional procedure for resection and anastomosis operates as follows. The first step is mobilization of a segment to be resected. Mobilization is achieved by freeing the intestine from its cavity attachment and is then followed by separating its blood supply. The mobilization can be conducted laparoscopically or through opening the peritoneal cavity. Second, resection of the segment to be removed follows the mobilization procedure. Often in removing the interior segment, the lumen of the bowel is opened, exposing the contaminated area to the clean peritoneal cavity, increasing the risk of postoperative complications. Following the resection of the segment to be removed, the remaining ends of the bowel are anastomosed to guarantee the continuity of the intestinal track.
Complications can occur in such procedures because, at times, the anastomosis can rupture for various reasons and can leak into the peritoneal cavity increasing the morbidity and mortality rate of such procedures. See Biagio Ravo "Colorectal Anastomotic Healing and Intercolonic Bypass Procedure". Surgical Clinic North America 1988;68(6), Pages 1267-1294.
Techniques are a major factor in maintaining the integrity of an anastomosis. Multiple techniques are described in the literature to achieve this goal. However, studies have shown that leakage rates remain substantially constant between mechanical and suture techniques.
The intestine is like a tunnel communicating with the outside environment through the mouth and the anus, therefore making its luminal contents contaminated. The bowel wall separates the contaminated interior area from the clean area of the peritoneal cavity. Complications can occur when the bowel wall is compromised which allows communication between the contaminated area within the bowel and the clean area outside the bowel within the peritoneal cavity. With this understanding, the lumen of the intestine is exterior to the body. It is possible to resect any piece of the intestinal wall from the lumen without ever communicating the dirty intraluminal content to the clean peritoneal cavity, assuming that the bowel has been mobilized from its attachments. This has already been disclosed in an experimental study, "Perineal Transanal Colonic Resection: An Experimental Study" by Biagio Ravo, M.D. et al., in Diseases of the Colon & Rectum, January 1986, Vol. 29, No. 1. In this study conducted on dogs, the colon was intussuscepted through the anus to the desired length followed by resection and anastomosis of the colon outside the clean body cavity. The intussusception of the colon at the anus allows the resection to be conducted outside the body cavity, preventing contamination of the body cavity.
The same resection of the colon as described above can be performed higher up in the lumen of the colon by using the technique of intussusception of the segment of the colon to be removed. This technique was described at our Scientific Exhibit, American College of Surgeons in June 1995. The difficulty with the proposed procedure to be applied to any part of the exterior track is that there is no conventional device allowing for the intussusception, anastomosis and resection of the intussuscepted segment.
It is an object of the present invention to overcome the aforementioned drawbacks of the prior art and to provide an intraluminal anastomotic device which can intussuscept anastomosis and resect its segment of the colon, without exposing the dirty intraluminal content to the clean cavity achieved before the resection is completed. The present invention differs completely from the prior art devices because it is able to complete an anastomosis prior to the resection of the segment to be removed preventing the problem which can occur when the intraluminal contents (fecal material) contaminate the interior of the body cavity (e.g. the peritoneal cavity, thoracic cavity, etc.).